Healthcare Provider Details

I. General information

NPI: 1073007340
Provider Name (Legal Business Name): OUTPATIENT PHARMACY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 ESSEX ST STE 202
ROCHELLE PARK NJ
07662-4347
US

IV. Provider business mailing address

120 E 56TH ST RM 900
NEW YORK NY
10022-3644
US

V. Phone/Fax

Practice location:
  • Phone: 201-991-0800
  • Fax: 201-991-1980
Mailing address:
  • Phone: 212-380-6866
  • Fax: 201-991-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DR. MEYER DAVIDOFF
Title or Position: CEO
Credential: PHARMD
Phone: 201-880-7000